Evidence-based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review

Abstract

Tinea cruris and tinea corporis are common fungal infections. Most can be treated with a variety of topical antifungals. This review aimed to assess the evidence for the effectiveness and safety of topical treatments for tinea cruris and tinea corporis. Searches included the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase, LILACS and ongoing trials registries (August 2013). One hundred and twenty-nine randomized controlled trials (RCTs) with 18 086 participants evaluated a range of interventions - mostly azoles. Pooling of data for several outcomes was only possible for two individual treatments. In five studies, terbinafine showed a statistically significant higher clinical cure rate compared with placebo [risk ratio (RR) 4·51, 95% confidence interval (CI) 3·10-6·56]. Data for mycological cure could not be pooled owing to substantial heterogeneity. Across three studies, mycological cure rates favoured naftifine (1%) compared with placebo (RR 2·38, 95% CI 1·80-3·14) but the quality of the evidence was low. Combinations of azoles with corticosteroids were slightly more effective than azoles for clinical cure, but there was no statistically significant difference with regard to mycological cure. Sixty-five studies were assessed as 'unclear' and 64 as being at 'high risk' of bias; many were over 20 years old, and most were poorly designed and inadequately reported. Although most active interventions showed sufficient therapeutic effect, this review highlights the need for further, high-quality, adequately powered RCTs to evaluate the effects of these interventions, which can ultimately provide reliable evidence to inform clinical decision making.

Drug Prescribing Pattern in Dermatophytosis at the Medical Outpatient Clinic of a Tertiary Healthcare in Karnataka, India

“…Zuuren and Fedorowics reported that combination of Azoles with Corticosteroids were slightly more effective than azoles for clinical cure in tineacruris and tineacoporis but there was no statistically significant difference with regards to mycological cure [11]. Havlickova and Friedrich recommended combination therapy of topical antifungal with a topical corticosteroids for tinea infection associated with inflammation [12].…”

Atypical psoriasis

“…Moreover, topical steroids can be transiently effective on mycological lesions, by resolving the pruritus and alleviating the burning sensation and inflammation. 11 Dermatological conditions, including dermatophytoses, are common in clinical practice. 12 In France and the United Kingdom, most patients with skin lesions first consult their GP.…”

Topical antifungal‐corticosteroid combination therapy for the treatment of superficial mycoses: conclusions of an expert panel meeting

“…It has been suggested that corticosteroids may interfere with the therapeutic action of the antifungal agent, or increase fungal growth as a result of decreased localised immune response . However, a number of studies have demonstrated that there is no significant difference in the rate of mycological cure between antifungal‐corticosteroid combination therapy and antifungal monotherapy . Moreover, antifungal‐corticosteroid combination therapy demonstrates more rapid therapeutic activity, and has been shown to be more effective in achieving clinical cure (the absence of symptoms such as erythema and pruritus) than topical antifungal therapy alone .…”